Evaluation of the Anxiety-Reducing Effects of Aroma Stones with Bergamot Essential Oil before Examinations: A Randomized Controlled Trial

BACKGROUND: Examinations are highly stressful for students and can impair their academic performance and mental well-being. While aromatherapy is used to relieve stress, its effectiveness during acute stress periods, such as pre-exam situations, remains underexplored. OBJECTIVE: To evaluate the effectiveness of aromatherapy with bergamot essential oil using aroma stones in reducing pre-exam anxiety among university students. METHODS: A randomized, parallel-group, open-label trial was performed with 57 Hoshi University undergraduates. Participants were assigned to either an intervention group (aroma stones infused with bergamot essential oil) or a control group (stones with water) for 3 days. The primary outcome was the change from baseline in the State Anxiety Inventory (SAI) scores at 180 min on each of the 3 days immediately preceding the regular examinations; secondary outcomes included the Short-form Measure of Relaxation Effects (S-MARE), Stanford Sleepiness Scale (SSS), Depression Anxiety Stress Scale (DASS-21), and Subjective Happiness Scale (SHS). Improvements were observed in the total and subscale scores of the S-MARE. The SSS scores indicated lower sleepiness only on Day 2. The SHS scores were significantly higher on the day before the exam. No significant between-group differences in DASS-21 scores were observed. Moreover, no intervention-related adverse events were reported. CONCLUSION: Aromatherapy with bergamot essential oil using aroma stones may reduce pre-exam anxiety and promote relaxation and well-being. This simple, noninvasive method may have potential as a practical psychological support tool in pre-examination educational settings, although the findings should be interpreted cautiously given the single-center design and relatively small sample size.